Reproductive
Clusters of sociodemographic and socioeconomic factors and preconception folic acid supplementation in the National Birth Defects Prevention Study, U.S. 2004-2011 Julie M. Petersen* Julie Petersen Eirini Nestoridi Rashida S. Smith-Webb Wendy Nembhard Jenil Patel Bailey Wallace Shannon Evans Suzan L. Carmichael Gary Shaw Martha Werler Mahsa Yazdy Anne Marie Darling the National Birth Defects Prevention Study
Background: Disparities in preconception folic acid (FA)-containing supplement use are well documented. However, limited research has examined the intersection of sociodemographic and socioeconomic factors to identify subgroups in greatest need of intervention.
Methods: Data were from US women who birthed liveborn, nonmalformed infants 2004-2011. Seven individual and 19 census tract variables were input in a hierarchical clustering model to define common patterns of sociodemographic and socioeconomic factors and determine whether they correspond with differences in any FA supplement use 1 month before pregnancy. Supplement use was not included in the algorithm.
Results: The algorithm identified 5 clusters (A n=502, B n=1448, C n=1294, D=738, E n=1351). The proportion of women supplementing with FA increased across Clusters A (13.6%), B (25.8%), C (33.2%), D (37.7%), and E (54.0%). As supplement use increased, some patterns emerged. For instance, the following maternal characteristics decreased: age <20 years, less than a high school education, and household income <$10,000; the proportion with census tract crowding index and income:poverty ratio <1 above the median also decreased. Cluster A had the highest proportion of Hispanic women, Clusters C and E were predominantly non-Hispanic White, and Clusters B and D had the most women identifying as non-Hispanic Black and residing in census tracts with a higher than median proportion of Black residents. Cluster A and C women resided in census tracts with higher than median proportions of manual workers. The proportion of women who intended the pregnancy was higher in Cluster E.
Conclusion: FA supplement use was consistently lower among clusters that tended to be younger, less educated, and have lower income. These data stress the correlations among social determinants of health and the need to understand barriers and develop interventions in socioeconomically deprived communities.
